The patient, a 24-year-old woman, was begun on Actrapid MC insulin and Novo Lente MC insulin therapy 6 months before admission. Four months later, her fasting blood glucose levels were around 300 mg/dl. The dose of insulin was gradually increased had Monotard insulin was substituted for the Novo Lente MC. The patient's diabetes was uncontrolled. One month before admission when Insulatard insulin was substituted for Novo Lente MC, she noticed generalized urticaria. She was admitted to our hospital because of the symptoms and uncontrolled diabetes, even on taking 160 units of Monocomponent insulin daily.
On admission, her height was 159 cm and her weight was 40 kg. She did not show any diabetic complications. Immunoglobulin analysis revealed IgE 2510 IU/ml and IgG 1280 mg/dl. The ¹²⁵I-insulin binding rate, total and free IRI levels were 85%, 43151 μU/ml, and 57.3 μU/ml, respectively. The serum and urinary CPR levels were almost zero. Anti-insulin receptor antibody was negative and other hyperglycemic causes were discounted endocrinologically. Direct intradermal skin tests for insulin, i. e. Novo Lente MC, Actrapid MC, Biosynthetic and Semi-synthetic Human insulin, were positive.
She was treated cautiously with continuous. Semi-synthetic Human insulin infusion, with desensitization of insulin by continuous subcutaneous infusion. Although her insulin allergy could not be eliminated completely, addition of hydrocortisone (5 mg) satisfactorily suppressed the reactions. Her diabetes mellitus was controlled well by the intramuscular injection of both 160 units of Semisynthetic Human insulin and 15 mg hydrocortisone daily. Her serum IgE, total and free IRI levels were 1908 μU/ml, 7535 μU/ml and 23.2 μU/ml, respectively, just before discharge.